|
HC SCHILLINGS W/O INTRINSIC FACTOR
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 78270
|
| Hospital Charge Code |
909301357
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$120.91 |
| Max. Negotiated Rate |
$501.00 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$430.19
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$452.24
|
| Rate for Payer: Heritage Provider Network Senior |
$452.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
|
|
HC SCHILLINGS W/O INTRINSIC FACTOR
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 78270
|
| Hospital Charge Code |
909301357
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$120.91 |
| Max. Negotiated Rate |
$567.80 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$412.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$501.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.13
|
| Rate for Payer: Blue Shield of California Commercial |
$407.48
|
| Rate for Payer: Blue Shield of California EPN |
$325.98
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$434.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$567.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$413.49
|
| Rate for Payer: Heritage Provider Network Senior |
$413.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$318.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$467.60
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$334.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$334.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$567.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.80
|
| Rate for Payer: Vantage Medical Group Senior |
$567.80
|
|
|
HC SCHILLINGS W & WO INTRINSIC FACTOR
|
Facility
|
OP
|
$1,142.00
|
|
|
Service Code
|
CPT 78272
|
| Hospital Charge Code |
909301359
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$206.70 |
| Max. Negotiated Rate |
$970.70 |
| Rate for Payer: Adventist Health Commercial |
$228.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$705.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$628.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$856.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$571.23
|
| Rate for Payer: Blue Shield of California Commercial |
$696.62
|
| Rate for Payer: Blue Shield of California EPN |
$557.30
|
| Rate for Payer: Cash Price |
$513.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$742.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$970.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$970.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$742.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$706.90
|
| Rate for Payer: Heritage Provider Network Senior |
$706.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$544.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$206.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$799.40
|
| Rate for Payer: Multiplan Commercial |
$856.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$571.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$571.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$970.70
|
| Rate for Payer: Vantage Medical Group Senior |
$970.70
|
|
|
HC SCHILLINGS W & WO INTRINSIC FACTOR
|
Facility
|
IP
|
$1,142.00
|
|
|
Service Code
|
CPT 78272
|
| Hospital Charge Code |
909301359
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$206.70 |
| Max. Negotiated Rate |
$856.50 |
| Rate for Payer: Adventist Health Commercial |
$228.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$735.45
|
| Rate for Payer: Cash Price |
$513.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$773.13
|
| Rate for Payer: Heritage Provider Network Senior |
$773.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$206.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.50
|
| Rate for Payer: Multiplan Commercial |
$856.50
|
|
|
HC SCL 70 AB
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913525
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$144.59 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$105.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.59
|
| Rate for Payer: Blue Shield of California Commercial |
$144.35
|
| Rate for Payer: Blue Shield of California Commercial |
$144.35
|
| Rate for Payer: Blue Shield of California EPN |
$115.78
|
| Rate for Payer: Blue Shield of California EPN |
$115.78
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.24
|
| Rate for Payer: Heritage Provider Network Senior |
$105.85
|
| Rate for Payer: Heritage Provider Network Senior |
$27.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$81.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SCL 70 AB
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913525
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.12
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.77
|
| Rate for Payer: Heritage Provider Network Senior |
$115.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
|
|
HC SCL70AB
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913710
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.17
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.89
|
| Rate for Payer: Heritage Provider Network Senior |
$14.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
|
|
HC SCL70AB
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913710
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$144.59 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.59
|
| Rate for Payer: Blue Shield of California Commercial |
$144.35
|
| Rate for Payer: Blue Shield of California Commercial |
$144.35
|
| Rate for Payer: Blue Shield of California EPN |
$115.78
|
| Rate for Payer: Blue Shield of California EPN |
$115.78
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SCLEROTHERAPY FLUID COLLECTION
|
Facility
|
OP
|
$3,879.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
909049185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$702.10 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$775.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,397.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,745.55
|
| Rate for Payer: Cash Price |
$1,745.55
|
| Rate for Payer: Cash Price |
$1,745.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,521.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,401.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,612.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,036.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$702.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$969.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$2,909.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,336.65
|
| Rate for Payer: TriValley Medical Group Senior |
$2,336.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC SCLEROTHERAPY FLUID COLLECTION
|
Facility
|
IP
|
$3,879.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
909049185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$702.10 |
| Max. Negotiated Rate |
$2,909.25 |
| Rate for Payer: Adventist Health Commercial |
$775.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,498.08
|
| Rate for Payer: Cash Price |
$1,745.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,626.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,626.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$702.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$969.75
|
| Rate for Payer: Multiplan Commercial |
$2,909.25
|
|
|
HC SCRAPING OF CORNEA, DIAG/SMEAR
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 65430
|
| Hospital Charge Code |
900501649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$213.81
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC SCRAPING OF CORNEA, DIAG/SMEAR
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 65430
|
| Hospital Charge Code |
900501649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$205.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$157.70
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$574.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$158.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$660.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$199.20
|
| Rate for Payer: TriValley Medical Group Senior |
$199.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC SCRENG VIRTUAL CT COLONOGRAPHY
|
Facility
|
OP
|
$1,172.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201972
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$212.13 |
| Max. Negotiated Rate |
$3,301.97 |
| Rate for Payer: Adventist Health Commercial |
$234.40
|
| Rate for Payer: Adventist Health Commercial |
$417.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,290.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$724.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,044.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$586.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,301.97
|
| Rate for Payer: Blue Shield of California Commercial |
$3,301.97
|
| Rate for Payer: Blue Shield of California EPN |
$2,655.33
|
| Rate for Payer: Blue Shield of California EPN |
$2,655.33
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$995.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$559.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$377.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$212.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$879.00
|
| Rate for Payer: Multiplan Commercial |
$1,566.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,113.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,113.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,113.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,113.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC SCRENG VIRTUAL CT COLONOGRAPHY
|
Facility
|
IP
|
$2,088.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201972
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$377.93 |
| Max. Negotiated Rate |
$1,566.00 |
| Rate for Payer: Adventist Health Commercial |
$417.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,344.67
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,413.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,413.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$377.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.00
|
| Rate for Payer: Multiplan Commercial |
$1,566.00
|
|
|
HC SD RECOVERY ADDL 30 MIN
|
Facility
|
IP
|
$684.00
|
|
| Hospital Charge Code |
907201508
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$440.50
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.07
|
| Rate for Payer: Heritage Provider Network Senior |
$463.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.00
|
| Rate for Payer: Multiplan Commercial |
$513.00
|
|
|
HC SD RECOVERY ADDL 30 MIN
|
Facility
|
OP
|
$684.00
|
|
| Hospital Charge Code |
907201508
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$422.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$376.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$513.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.14
|
| Rate for Payer: Blue Shield of California Commercial |
$417.24
|
| Rate for Payer: Blue Shield of California EPN |
$333.79
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$444.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$581.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$581.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$581.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$403.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.40
|
| Rate for Payer: Heritage Provider Network Senior |
$423.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$326.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$478.80
|
| Rate for Payer: Multiplan Commercial |
$513.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$342.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$342.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$581.40
|
| Rate for Payer: Vantage Medical Group Senior |
$581.40
|
|
|
HC SD RECOVERY LEVEL IV FIRST HR
|
Facility
|
IP
|
$1,628.00
|
|
| Hospital Charge Code |
906500107
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$294.67 |
| Max. Negotiated Rate |
$1,221.00 |
| Rate for Payer: Adventist Health Commercial |
$325.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,048.43
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,102.16
|
| Rate for Payer: Heritage Provider Network Senior |
$1,102.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$294.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.00
|
| Rate for Payer: Multiplan Commercial |
$1,221.00
|
|
|
HC SD RECOVERY LEVEL IV FIRST HR
|
Facility
|
OP
|
$1,628.00
|
|
| Hospital Charge Code |
906500107
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$294.67 |
| Max. Negotiated Rate |
$1,383.80 |
| Rate for Payer: Adventist Health Commercial |
$325.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,006.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,383.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$895.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,221.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$814.33
|
| Rate for Payer: Blue Shield of California Commercial |
$993.08
|
| Rate for Payer: Blue Shield of California EPN |
$794.46
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,058.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,383.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,383.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,383.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$960.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,007.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,007.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$776.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$294.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,139.60
|
| Rate for Payer: Multiplan Commercial |
$1,221.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$814.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$814.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,383.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,383.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,383.80
|
|
|
HC SECONDARY ART M-THROMB ADD-ON
|
Facility
|
IP
|
$16,468.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
909081845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,980.71 |
| Max. Negotiated Rate |
$12,351.00 |
| Rate for Payer: Adventist Health Commercial |
$3,293.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,605.39
|
| Rate for Payer: Cash Price |
$7,410.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,148.84
|
| Rate for Payer: Heritage Provider Network Senior |
$11,148.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,980.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,117.00
|
| Rate for Payer: Multiplan Commercial |
$12,351.00
|
|
|
HC SECONDARY ART M-THROMB ADD-ON
|
Facility
|
OP
|
$16,468.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
909081845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$13,997.80 |
| Rate for Payer: Adventist Health Commercial |
$3,293.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,177.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,997.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,057.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,351.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$7,410.60
|
| Rate for Payer: Cash Price |
$7,410.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,704.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,997.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,997.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,997.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,193.69
|
| Rate for Payer: Heritage Provider Network Senior |
$10,193.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,855.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,980.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,117.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,527.60
|
| Rate for Payer: Multiplan Commercial |
$12,351.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,997.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,997.80
|
| Rate for Payer: Vantage Medical Group Senior |
$13,997.80
|
|
|
HC SEDATION EA ADDL 15 MIN
|
Facility
|
IP
|
$491.00
|
|
| Hospital Charge Code |
907201215
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$88.87 |
| Max. Negotiated Rate |
$368.25 |
| Rate for Payer: Adventist Health Commercial |
$98.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$316.20
|
| Rate for Payer: Cash Price |
$220.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$332.41
|
| Rate for Payer: Heritage Provider Network Senior |
$332.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.75
|
| Rate for Payer: Multiplan Commercial |
$368.25
|
|
|
HC SEDATION EA ADDL 15 MIN
|
Facility
|
OP
|
$491.00
|
|
| Hospital Charge Code |
907201215
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$88.87 |
| Max. Negotiated Rate |
$417.35 |
| Rate for Payer: Adventist Health Commercial |
$98.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$303.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$417.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$270.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$368.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.60
|
| Rate for Payer: Blue Shield of California Commercial |
$299.51
|
| Rate for Payer: Blue Shield of California EPN |
$239.61
|
| Rate for Payer: Cash Price |
$220.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$319.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$417.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$417.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$303.93
|
| Rate for Payer: Heritage Provider Network Senior |
$303.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$234.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$343.70
|
| Rate for Payer: Multiplan Commercial |
$368.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$245.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$245.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$417.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.35
|
| Rate for Payer: Vantage Medical Group Senior |
$417.35
|
|
|
HC SEDATION GT 5 YRS FIRST 15 MIN
|
Facility
|
IP
|
$1,292.00
|
|
| Hospital Charge Code |
907201214
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$233.85 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Adventist Health Commercial |
$258.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$832.05
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$874.68
|
| Rate for Payer: Heritage Provider Network Senior |
$874.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.00
|
| Rate for Payer: Multiplan Commercial |
$969.00
|
|
|
HC SEDATION GT 5 YRS FIRST 15 MIN
|
Facility
|
OP
|
$1,292.00
|
|
| Hospital Charge Code |
907201214
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$233.85 |
| Max. Negotiated Rate |
$1,098.20 |
| Rate for Payer: Adventist Health Commercial |
$258.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$798.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,098.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$710.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$969.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$646.26
|
| Rate for Payer: Blue Shield of California Commercial |
$788.12
|
| Rate for Payer: Blue Shield of California EPN |
$630.50
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$839.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,098.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,098.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,098.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$762.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$799.75
|
| Rate for Payer: Heritage Provider Network Senior |
$799.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$616.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$904.40
|
| Rate for Payer: Multiplan Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$646.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$646.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,098.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,098.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,098.20
|
|
|
HC SEDATION LT 5 YRS FIRST 15 MIN
|
Facility
|
IP
|
$1,292.00
|
|
| Hospital Charge Code |
907201213
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$233.85 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Adventist Health Commercial |
$258.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$832.05
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$874.68
|
| Rate for Payer: Heritage Provider Network Senior |
$874.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.00
|
| Rate for Payer: Multiplan Commercial |
$969.00
|
|
